Provider Demographics
NPI:1831287994
Name:SECURE HAVEN ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:SECURE HAVEN ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARRIS
Authorized Official - Middle Name:DON
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DM
Authorized Official - Phone:214-339-4320
Mailing Address - Street 1:2837 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-1005
Mailing Address - Country:US
Mailing Address - Phone:214-339-4920
Mailing Address - Fax:214-339-3603
Practice Address - Street 1:2837 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-1005
Practice Address - Country:US
Practice Address - Phone:214-339-4920
Practice Address - Fax:214-339-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117015311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1=========6000OtherSTATE OF TEXAS ID NUMBER